Transcript Where Are We Going?

William Frank Barker, LPC, MAC


Diane Diver, LMSW, CAC II
Physician’s
Office
Legal
System &
Jail
Mental
Health
Institutions
Outpatient
Alcoholics
Anonymous
Minnesota
Model
Health
Care
Reform
Clinical
Trends
$
28 Billion spent in 2010 to treat
addiction which affects 40 million
people
Versus
$107
Billion to treat heart disease
which affects 27 million people
McLellan et al., JAMA, 2000.
Drug
Addiction
Type I
Diabetes
Hypertension
50 to 70%
50 to 70%
30 to 50%
100
90
80
70
60
50
40
30
20
10
0
40 to 60%
Percent of Patients Who Relapse
Relapse Rates Are Similar for Drug Addiction
& Other Chronic Illnesses
Asthma
Parity
Estimated U.S. Economic Cost to Society Due to
Substance Abuse and Addiction
Illegal Drugs
Alcohol
Tobacco
-
$181 billion/year
$185 billion/year
$158 billion/year
Total
-
$524 billion/year
Source: Surgeon General’s Report, 2004; ONCP, 2004; Harwood, 2000.arwood, 2000. Surgeon General’s Report, 2004; ONDCP, 2004; Harwood, 2000.
How Its Funded
Current Spending on Substance
Abuse Treatment
5%
17%
20%
45%
14%
Private Funding
Medicaid
Other Federal
Other State and Local
Medicare


More people with 3rd party insurance
Shifts cost and focus: deductibles, reimbursement rates,
outcome orientation, primary care physician

Shift from management and administration of block grants
to focus on “best practices,” grants, and outcome
measurements.

2 Million people in US dependent/abuse opioids
18,582 Physicians are certified to prescribe
buprenorphine.
 9% of SA facilities are Opioid Treatment Programs (OTP) in
2011


Individuals receiving buprenorphine prescriptions in 2010 was
800,000 with only 5% coming from treatment programs

Emergency department visits involving buprenorphine
increased from 3,161 in 2005 to 30,135 visits in 2010 as
availability of the drug increased.
Source: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (April 23, 2013). The N-SSATS
Report: Trends in the Use of Methadone and Buprenorphine at Substance Abuse Treatment Facilities: 2003 to 2011. Rockville, MD.
2010 Emergency Department Visits
Involving Buprenorphine by Type
Nonmedical Use of
Pharmaceuticals
10.00%
13.00%
52.00%
Seeking
Detoxification/Treatment
Services
Adverse Reaction
24.00%
Other
Source: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (January 29, 2013). The DAWN
Report: Emergency Department Visits Involving Buprenorphine. Rockville, MD.
NIDA’s Principles of Treatment
• No single treatment is appropriate for all
individuals.
• Treatment needs to be readily available.
• Treatment must attend to multiple needs of the
individual, not just drug use.
• Multiple courses of treatment may be required
for success.
• Remaining in treatment for an adequate
period of time is critical for treatment
effectiveness.
NIDA’s Principles of Treatment
Behavioral Therapies:
 Cognitive Behavioral Therapy
 Contingency Management Interventions/Motivational
Incentives
 Community Reinforcement Approach Plus Vouchers
 Motivational Enhancement Therapy
 The Matrix Model
 12-Step Facilitation Therapy
 Family Behavior Therapy
 Behavioral Therapies
“You can’t do cognitive therapy from a
manual any more than you can do
surgery from a manual.”
-Aaron T. Beck, New York Times
 1900s
“Being on the wagon”
 1930s
“Not drinking alcohol”
 1980
Sober is being totally
chemically free
 1990-2000
Relapse is a part of recovery
Audrey Kishline

2000
Evidence based practices
• Moderate drinking
• Fewer drinking days
 Addiction
is a primary, chronic disease of brain
reward, motivation, memory and related
circuitry. Dysfunction in these circuits leads to
characteristic biological, psychological, social
and spiritual manifestations. This is reflected in
an individual pathologically pursuing reward
and/or relief by substance use and other
behaviors.
 Addiction
is characterized by the inability to
consistently abstain, impairment in behavioral
control, craving, diminished recognition of
significant problems with one’s behaviors and a
dysfunctional emotional response. Like other
chronic diseases, addiction often involves cycles
of relapse and remission. Without treatment or
engagement in recovery activities, addiction is
progressive and can result in disability or death.
 The
focus in the past has been generally on
substances associated with addiction.
 The
new definition clarifies that addiction isn't
about drugs, it’s about brains.
 It
is not the substance or the quantity or
frequency of use that makes them an addict.
Addiction is about what happens in the reward
circuitry of the brain when exposed to a
rewarding substance or behavior.
More Severe
Detoxification
Residential
Treatment
Day Treatment
Intensive Outpatient Treatment
General Outpatient Treatment
Less Severe
The Acute Model Vs. ASAM Levels of Care
1.
Would significantly increase the number of people
being diagnosed with addiction.
2.
The APA has not allowed enough discussion
regarding these changes (secondary gain).
3.
It could create false epidemics and medicalication
of everyday behavior.
4.
Possible boundary issues between DSM panel
members and the pharmaceutical companies.
ACCOUNTABILITY COURTS
USE OF TECHNOLOGY
Health
Care
Reform
Highly
Trained
Clinical
Trends
Peer
Recovery
Supports
 Medication
Assisted Treatment
 Physician
Office/Counselor Embedded
Treatment
 Technology
becomes a major tool
 Increased qualifications for workforce
 Serve
More people
 Prison/Drug courts may become converted
to one payer